Articles

Who’s on First?

I was on a flight recently and while chatting with the person next to me, I had to explain something that made me think of the old Abbott and Costello routine, “Who’s on First?”

My fellow passenger asked what I did, and I said, “I’m a PA.” I was elated that she knew what that was and I didn’t have to explain. She had seen an emergency medicine PA who had given her outstanding care. So far, so good.

Then she asked me my specialty. When I said “family practice,” she seemed confused. She said, “Oh, you’re an internist.”

I said, “No, not exactly. Although I do a lot of what is done in internal medicine, I also see children.”

She asked, “Oh, then you’re a pediatrician?”

I said, “No, again, not exactly. I see adults and children, and geriatric patients, too, and women for their gynecological needs. I also see patients with urgent issues and suture and cast.”

Now she was really confused.

So, I thought about this for a while as I tried to untangle in her mind what those of us in family practice do. In the end, she said, “So, you’re like an old fashioned GP, right?”

Again, I said, “Close, but not exactly.” I tried to explain that family medicine is an actual specialty and that we provide care for patients’ chronic and subacute illnesses from cradle to grave, focusing upon wellness and preventive care. I also tried to explain that this kind of medicine requires special skills, just like surgery or oncology.

But she shut me down with her last comment: “But because your knowledge is so general, you probably don’t get paid very much, do you?”

Ouch! That’s gonna leave a mark!

So, to paraphrase Rodney Dangerfield, why does family practice get no respect? Data say that family practitioners need to make more complex decisions per hour than almost any other specialty, but we are paid less. And when PA students are being mentored, they hear things like, “You want to go into family practice? Why would you do that when you’re so bright?”

And on the question of salary: It’s time to declare that we family practitioners possess an economically undervalued skill set. Consider what we bring to the practice of medicine: detailed and personalized counseling of patients across the spectrum of life, a unique role coordinating care among all specialists, and providing preventive care. These skills are not only unique, but provide value to medicine. Family practitioners are the first line of patient care.

So, as Costello asked, “Who’s on first?” And perhaps more importantly, what do we do when the answer is, “Nobody”?

Lawrence Herman, PA-C, MPA, DFAAPA, is an Associate Professor in the Department of Physician Assistant Studies, New York Institute of Technology, Old Westbury, NY, and AAPA President-elect.